Post-operative radiological outcome of ankle fractures after treatment by orthopaedic registrars

Abstract

Background: Ankle fractures are the commonest fractures encountered by orthopaedic surgeons. They account for 10% of all orthopaedic fractures treated in the emergency departments. Orthopaedic registrars are expected to accurately diagnose and surgically manage these fractures during their training and progression towards competent and independent practice. This study aimed to evaluate the post-operative radiological outcome of ankle fractures treated by orthopaedic registrars at Chris Hani Baragwanath Academic Hospital (CHBAH).

Methodology: This was a retrospective cross-sectional study of ankle fractures treated with open reduction and internal fixation by registrars at CHBAH from 01 January 2018 to 30 June 2018. Only Weber A, B1 and B2 fractures were included while B3 and C fractures were excluded. Post-operative x-rays were used to measure TCA (Talocrural angle and MCS (medial clear space). These measurements were used to determine the accuracy of fracture reduction in order to assess the competence of registrars. Secondarily, checked if these were influenced by registrars’ seniority or timing of surgery. Study permission received in December 2018 and ethics approval in April 2019 after which data collection commenced. Measurements were confirmed by a blinded independent observer (IO), Dr Kgabo (qualified orthopaedic surgeon).

Results: A total number of 98 patients were surgically treated for Weber B ankle fractures during the study period. Only 64 patients met the inclusion criteria while 34 were excluded. The mean age of studied participants was 41.3 years. Female patients accounted for 64 % of studies cases while males accounted for 36%. The right ankle was the most fractured side (59.4%). Majority (79.7%) of the operated ankles had good radiological outcome. Surgeries performed between 00:00 and 06:59 hrs were 5.8 times more likely to have a poor radiological outcome compared to those performed between 07:00 and 23:59 hrs. Seniority of the registrars did not show any influence in radiological outcome.

Conclusion: Majority (79.7%) of ankle fractures surgically treated by the registrars at CHBAH had good radiological outcome, with only 20.3% showing the poor results. Timing of surgery had an influence in radiological outcome as oppose to registrars’ seniority